42 Babies Out Of 1,000 Die Before Reaching Age Of One Year In Country It is well known that quality of life varies greatly amongst different states within India. Some states have greater industrial or agricultural output, higher income levels, better education and health indicators, while others are still struggling with backwardness. But what is less known is that within states too, there are wide variations. State-level averages often hide huge and unconscionable disparity on life and death issues. Recently released data on infant mortality rates (IMR) — a key measure of health and wellbeing — shows that it varies widely within states like Maharashtra, Karnataka, Madhya Pradesh and Gujarat. IMR refers to the number of newborn babies that die before reaching teh age of one year, as a proportion of 1000 live births. These deaths are mostly due to treatable diseases or malnutrition. The data is part of the Sample Registration System (SRS) survey covering 7.35 million people conducted by the Census Office in 2012. In Gujarat’s arid districts of Kachchh, Banaskantha and Surendernagar, IMR is high at 51. This region is at the tail end of the Narmada waters coming from Sardar Sarovar. In contrast, the relatively better-off Saurashtra region’s six districts exhibit an IMR of just 31. Saurashtra is agriculturally much more advanced and fed by Narmada waters. Gujarat’s average IMR is 45, slightly higher than the national average of 42. Narayan Singh, a doctor at a primary health center in Kachchh told TOI that doctors’ availability and access to healthcare services are the key factors that determine IMR. In Kachchh, private doctors are fewer, while government centers are unable to cope with patients. Villages are far flung and people can’t reach health facilities in time. Maharashtra has an IMR of 30, well below the national average. But seven districts of the Vidarbha region have an IMR of 51, about 70% higher than the state average. In effect, Vidarbha’s babies face the same future as those in Rajasthan or Uttar Pradesh, although the Maharashtra state average doesn’t show that. In northern Maharashtra, Nandurbar, Dhule, Nashik and Jalgaon districts have an IMR of 23. Access to healthcare is only one of the factors, says T Sundaraman, executive director of the National Health Systems Resource Centre, which provides technical support to the government’s National Rural Health Mission. “Basic issues seem to be education, especially women’s education, access to safe water and sanitation, and malnutrition. The number of health care professionals (nurses+doctors) per 1000 population, both public and private, would also contribute to better or worse performance for a given level of education”, he said. In Madhya Pradesh, six districts of the central region, which includes Bhopal, have a shockingly high IMR of 70, while the Vindhya region, which includes the southern Bundelkhand districts, has an IMR of 68. The state average is 60, the highest in the country. Surprisingly, the tribal-dominated southwestern region of MP has the lowest IMR in the state at 46. Karnataka’s three districts in the coastal and ghat region have an IMR of just 16, comparable to the adjacent northern Kerala’s 14. But once one moves into interior Karnataka, the situation worsens — in the seven southern districts, including Bangalore, Mysore and Kolar, IMR is 44, higher than the state average of 36. IMR in Rajasthan’s southern and southeastern regions, which include Kota, Udaipur, Chittorgarh, Baran, and Dungarpur, is 66, much higher than the state average of 54. This tribal region is arid in its western reaches but not so much in the east. In Odisha, the tribal-dominated southern region has an IMR of 68, compared to the state average of 55. In many states, IMR variations are limited. These include lower IMR states like Punjab, Tamil Nadu, West Bengal and Kerala, and high IMR states like UP and Assam.